Online health information comes from a variety of online sources. Based on a typology of online sources, this research examines the direct and combined influences of original sources (doctors vs. laypersons) and selecting sources (Web sites vs. bulletin boards vs. blogs vs. personal home pages vs. Internet) on perceived credibility of—and behavioral intentions toward—health information. A large 2 (message) × 2 (original source) × 5 (selecting source) full-factorial online experiment revealed that respondents (N = 555) were more likely to take action based on the information sourced from a Web site than from a blog or a personal home page. The effect was mediated by perceived level of gatekeeping and perceived information completeness. The analysis also yielded a three-way interaction between message, original source, and selecting source on perceived credibility, suggesting the operation of an appropriateness heuristic when evaluating source combinations for less relevant health topics. Theoretical and practical implications are discussed, leading to the proposal of a new online source typology.
Ahern, D.K., Kreslake, J.M., & Phalen, J.M. ( 2006). What is ehealth (6): Perspectives on the evolution of ehealth research. Journal of Medical Internet Research, 8(1), e4. Retrieved June 18, 2007, from http://www.jmir.org/2006/1/e4/
2.
Barning, S., & Trammell, K. ( 2006, August). Revisiting the issue of blog credibility: A national survey. Paper presented at the annual convention of the Association for Education in Journalism and Mass Communication, San Francisco.
3.
Baron, R.M., & Kenny, D.A. ( 1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations . Journal of Personality and Social Psychology, 51, 1173-1182.
4.
Barzilai-Nahon, K. ( 2005). Network gatekeeping. In K. Fisher, S. Erdelez, & L. McKechnie (Eds.), Theories of information behavior (pp. 247-253). Medford, NJ: Information Today.
5.
Barzilai-Nahon, K. ( 2006). Gatekeepers, virtual communities and the gated: Multidimensional tensions in cyberspace. International Journal of Communications Law & Policy, Autumn. Retrieved October 21, 2009, from http://www.ijclp.net/files/ijclp_web-doc_9-11-2006.pdf
6.
Barzilai-Nahon, K. ( 2008). Toward a theory of network gatekeeping: A framework for exploring information control. Journal of the American Society for Information Science and Technology, 59(9), 1493-1512.
7.
Bass, S.B., Ruzek, S.B., Gordon, T.F., Fleisher, L., McKeown-Conn, N., & Moore, D. ( 2006). Relationship of Internet health information use with patient behavior and self-efficacy: Experiences of newly diagnosed cancer patients who contact the National Cancer Institute’s cancer information service. Journal of Health Communication, 11, 219-236.
8.
Bernhardt, J.M., & Felter, E.M. ( 2004). Online pediatric information seeking among mothers of young children: Results from a qualitative study using focus groups. Journal of Medical Internet Research, 6(1), e7. Retrieved June 18, 2007, from http://www.jmir.org/2004/1/e7
9.
Blanchard, A. ( 2004). Blogs as virtual communities: Identifying a sense of community in the Julie/Julia Project. In Into the Blogosphere . Retrieved June 18, 2007, from http://blog.lib.umn.edu/blogosphere/blogs_as_virtual.html
10.
Boberg, E.W., Gustafson, D.H., Hawkins, R.P., Offord, K.P., Koch, C., Wen, K.-Y., et al. (2003). Assessing the unmet information, support and care delivery needs of men with prostate cancer. Patient Education and Counseling, 49, 233-242.
11.
Boulding, W., Kalra, A., Staelin, R., & Zeithaml, V. ( 1993). A dynamic process model of service quality: From expectations to behavioral intentions. Journal of Marketing Research, 30, 7-27.
12.
Burgoon, J.K. ( 1976). The ideal source: A reexamination of source credibility measurement. Central States Speech Journal, 27, 200-206.
13.
Burrows, R., Nettleton, S., Pleace, N., Loader, B., & Muncer, S. ( 2000). Virtual community care? Social policy and the emergence of computer mediated social support. Information, Communication & Society, 3, 95-121.
14.
Chaiken, S. ( 1987). The heuristic model of persuasion. In M. P. Zanna, J. M. Olson, & C. P. Herman (Eds.), Social influence: The Ontario symposium (Vol. 5, pp. 3-39). Hillsdale, NJ: Lawrence Erlbaum.
15.
Chaiken, S., Lieberman, A., & Eagly, A.H. ( 1989). Heuristic and systematic information processing within and beyond the persuasion context. In J. S. Uleman, & J. A. Bargh (Eds.), Unintended thought (pp. 212-252). New York: Guilford.
16.
Cline, R.J.W., & Haynes, K.M. ( 2001). Consumer health information seeking on the Internet: The state of the art. Health Education Research, 16, 671-692.
17.
Cronin, J., & Taylor, S. ( 1992). Measuring service quality: A re-examination and extension . Journal of Marketing, 56(3), 55-68.
18.
Döring, N. ( 2002). Personal home pages on the Web: A review of research . Journal of Computer-Mediated Communication, 10. Retrieved June 18, 2007, from http://jcmc.indiana.edu/vol7/issue3/doering.html
19.
Dutta-Bergman, M.J. ( 2003). Health communication on the Web: The role of Web use motivation and information completeness. Communication Monographs , 70, 264-274.
20.
Dutta-Bergman, M.J. ( 2004). The impact of completeness and Web use motivation on the credibility of e-health information. Journal of Communication , 54, 253-269.
21.
Eastin, M.S. ( 2001). Credibility assessments of online health information: The effects of source expertise and knowledge of content. Journal of Computer-Mediated Communication, 6. Retrieved June 18, 2007, from http://jcmc.indiana.edu/vol6/issue4/eastin.html
22.
Eysenbach, G. ( 2003). The impact of the Internet on cancer outcomes. CA: A Cancer Journal for Clinicians, 53, 356-371.
23.
Eysenbach, G., & Köhler, C. (2002). How do consumers search for and appraise health information on the World-Wide-Web? Qualitative study using focus groups, usability tests and in-depth interviews. British Medical Journal, 324, 573-577.
24.
Eysenbach, G., Powell, J., Englesakis, M., Rizo, C., & Stern, A. ( 2004). Health related virtual communities and electronic support groups: Systematic review of the effects of online peer to peer interactions . British Medical Journal, 328(7449), 1166-1171.
25.
Eysenbach, G., Powell, J., Kuss, O., & Sa, E.-R. ( 2002). Empirical studies assessing the quality of health information for consumers on the World Wide Web. Journal of the American Medical Association, 287, 2691-2700.
26.
Ferguson, T. ( 1999). E-patients prefer egroups to doctors for 10 of 12 aspects of health care. Ferguson Report, 1. Retrieved June 18, 2007, from http://www.fergusonreport.com/articles/fr039905.htm
27.
Ferguson, T. ( 2002). From patients to end users. British Medical Journal, 324, 555-556.
28.
Fishbein, M., & Ajzen, I. ( 1975). Belief, attitude, intention and behavior: An introduction to theory and research. Reading, MA: Addison-Wesley.
29.
Flanagin, A.J., & Metzger, M.J. ( 2007). The role of site features, user attributes, and information verification behaviors on the perceived credibility of Web-based information . New Media & Society, 9, 319-342.
30.
Fox, N.J., Ward, K.J., & O’Rourke, A.J. (2005). The "expert patient": Empowerment or medical dominance? The case of weight loss, pharmaceutical drugs and the Internet. Social Science & Medicine, 60, 1299-1309.
31.
Fox, S. ( 2002). Search engines: A Pew Internet project data memo. Pew Internet & American Life Project. Retrieved June 18, 2007, from http://www.pewinternet.org/pdfs/PIP_Search_Engine_Data.pdf
32.
Fox, S. ( 2005). Health information online: Eight in ten Internet users have looked for health information online, with increased interest in diet, fitness, drugs, health insurance, experimental treatments, and particular doctors and hospitals. Pew Internet & American Life Project . Retrieved June 18, 2007, from http://www.pewinternet.org/pdfs/PIP_Healthtopics_May05.pdf
33.
Fox, S. ( 2006). Online health search 2006: Most Internet users start at a search engine when looking for health information online. Very few check the source and date of the information they find. Pew Internet & American Life Project. Retrieved June 18, 2007, from http://www.pewinternet.org/pdfs/PIP_Online_Health_2006.pdf
34.
Fox, S., & Fallows, D. ( 2003). Internet health resources: Health searches and email have become more commonplace, but there is room for improvement in searches and overall Internet access. Pew Internet & American Life Project. Retrieved June 18, 2007, from http://www.pewinternet.org/pdfs/PIP_Health_Report_July_2003.pdf
35.
Fox, S., & Rainie, L. ( 2002). Vital decisions: How Internet users decide what information to trust when they or their loved ones are sick. Plus a guide from the Medical Library Association about smart health-search strategies and good Web sites. Pew Internet & American Life Project. Retrieved June 18, 2007, from http://www.pewinternet.org/pdfs/PIP_Vital_Decisions_May2002.pdf
36.
Ginossar, T. ( 2008). Online participation: A content analysis of differences in utilization of two online cancer communities by men and women, patients and family members. Health Communication, 23, 1-12.
37.
Gray, N.J., Klein, J.D., Noyce, P.R., Sesselberg, T.S., & Cantrill, J.A. (2005). Health information-seeking behavior in adolescence: The place of the Internet. Social Science & Medicine, 60, 1467-1478.
38.
Haas, C., & Wearden, S.T. ( 2003). E-credibility: Building common ground in Web environments . L1 Educational Studies in Language and Literature, 3, 169-184.
39.
Hardey, M. ( 2001). "E-health": The Internet and the transformation of patients into consumers and producers of health knowledge. Information, Communication & Society, 4, 388-405.
40.
Houston, T.K., & Allison, J.J. ( 2002). Users of Internet health information: Differences by health status. Journal of Medical Internet Research, 4(2), e7. Retrieved June 18, 2007, from http://www.jmir.org/2002/2/e7
41.
Hovland, C.I., Janis, I.L., & Kelley, J.J. ( 1953). Communication and persuasion. New Haven, CT: Yale University Press.
42.
Hovland, C.I., & Weiss, W. ( 1951). The influence of source credibility on communication effectiveness. Public Opinion Quarterly, 15, 635-650.
43.
Hyden, L.C. ( 1997). Illness and narratives. Sociology of Health & Illness, 9, 48-69.
44.
Iyengar, S., & Kinder, D. R. (1987). News that matters. Chicago: University of Chicago Press. Johnson, T. J., & Kaye, B. K. (2002). Webelievability: A path model examining how convenience and reliance predict online credibility. Journalism & Mass Communication Quarterly, 79, 619-642.
45.
Johnson, T.J., & Kaye, B.K. ( 2004). Wag the blog: How reliance on traditional media and the Internet influence credibility perceptions of Weblogs among blog users. Journalism & Mass Communication Quarterly, 81, 622-642.
46.
Kaiser Family Foundation. (2001). Generation Rx.com: How young people use the Internet for health information . Menlo Park, CA: Henry J. Kaiser Family Foundation.
47.
Kiousis, S. ( 2001). Public trust or mistrust? Perceptions of media credibility in the information age. Mass Communication and Society, 4, 381-403.
48.
Kivits, J. ( 2004). Researching the "informed patient": The case of online health information seekers. Information, Communication and Society, 7, 510-530.
49.
Korp, P. ( 2006). Health on the Internet: Implications for health promotion . Health Education Research, 21, 78-86.
50.
Lacoursiere, S.P., Knobf, M.T., & McCokle, R. ( 2005). Cancer patients’ self-reported attitudes about the Internet. Journal of Medical Internet Research, 7(3), e22. Retrieved June 18, 2007, from http://www.jmir.org/2005/3/e22/
51.
Lasker, J.N., Sogolow, E.D., & Sharim, R.R. ( 2005). The role of an online community for people with a rare disease: Content analysis of messages posted on a primary biliary cirrhosis mailinglist. Journal of Medical Internet Research, 7(1), e10. Retrieved June 18, 2007, from http://www.jmir.org/2005/1/e10/
52.
Lenhart, A., & Fox, S. ( 2006). Bloggers: A portrait of the Internet’s new storytellers . Pew Internet & American Life Project. Retrieved June 18, 2007, from http://www.pewinternet.org/pdfs/PIP%20Bloggers%20Report%20July%2019%202006.pdf.
53.
Lenhart, A., Horrigan, J., & Fallows, D. ( 2004). Content creation online: 44% of U.S. Internet users have contributed their thoughts and their files to the online world. Pew Internet & American Life Project. Retrieved June 18, 2007, from http://www.pewinternet.org/pdfs/PIP_Content_Creation_Report.pdf
54.
McCroskey, J.C., & Richmond, V.P. (1996). Fundamentals of human communication . Prospect Heights, IL: Waveland Press.
55.
Metzger, M.J., Flanagin, A.J., Eyal, K., Lemus, D.R., & McCann, R.M. (2003). Credibility for the 21st century: Integrating perspectives on source, message, and media credibility in the contemporary media environment. Communication Yearbook , 27, 293-335.
56.
Metzger, M.J., Flanagin, A.J., & Zwarun, L. ( 2003). College student Web use, perceptions of information credibility, and verification behavior. Computers & Education, 41, 271-290.
57.
Nan, X. ( 2006, August). The influence of source credibility on attitude certainty. Paper presented at the annual convention of the Association for Education in Journalism and Mass Communication, San Francisco.
58.
Neuhauser, L., & Kreps, G.L. ( 2003). Rethinking communication in the e-health era. Journal of Health Psychology, 8(1), 7-23.
59.
Newhagen, J., & Nass, C. ( 1989). Differential criteria for evaluating credibility of newspapers and TV news. Journalism Quarterly, 66, 277-284.
60.
Owen, N., Fotheringham, M.J., & Marcus, B.H. ( 2002). Communication technology and health behavior change. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health behavior and health education (3rd ed., pp. 510-529). San Francisco: Jossey-Bass.
61.
Petty, R.E., & Cacioppo, J.T. (1986). Communication and persuasion: Central and peripheral routes to attitude change. New York : Springer-Verlag.
62.
Pedhazur, E.J., & Schmelkin, L.P. (1991). Measurement, design, and analysis: An integrated approach. Hillsdale, NJ: Lawrence Erlbaum Association.
63.
Petty, R.E., & Cacioppo, J.T. (1986). Communication and persuasion: Central and peripheral routes to attitude change. New York : Springer-Verlag.
64.
Radin, P. ( 2006). "To me, it’s my life": Medical communication, trust, and activism in cyberspace. Social Science & Medicine , 62, 1299-1309.
65.
Rains, S.A. ( 2007). The anonymity effect: The influence of anonymity on perceptions of sources and information on health Web sites. Journal of Applied Communication Research, 35, 197-214.
66.
Reeves, B., & Nass, C. ( 1996). The media equation: How people treat computers, televisions, and new media like real people and places. Stanford, CA : CSLI/Cambridge University Press.
67.
Rosenvinge, J.H., Laugerud, S., & Hjortdahl, P. ( 2003). Trust in health Web sites: A survey among Norwegian Internet users. Journal of Telemedicine and Telecare, 9(3), 161-166.
68.
Scott, L.C. ( 2004a, August). Deliberative communities online: Towards a model of civic journalism based on the blog. Paper presented at the annual convention of the Association for Education in Journalism and Mass Communication, Toronto, Ontario, Canada.
69.
Scott, L.C. ( 2004b, August). Late modern life and the rise of the "blogosphere": Can new media meet life’s new challenges?Paper presented at the annual convention of the Association for Education in Journalism and Mass Communication, Toronto, Ontario , Canada.
70.
Shoemaker, P.J., Eicholz, M., Kim, E., & Wrigley, B. ( 2001). Individual and routine forces in gatekeeping. Journalism & Mass Communication Quarterly, 78, 233-246.
71.
Siow, T.R., Soh, I.P.T., Sreedharan, S., De, S.D., Tan, P.P., & Seow, A., et al. (2003). The Internet as a source of health information among Singaporean: Prevalence, patterns of health surfing and impact on health behavior. Annals Academic of Medicine Singapore, 32, 807-813.
72.
Smedley, B., & Syme, S. L. (Eds.). (2000). Promoting health: Intervention strategies from social and behavioral research. Institute of Medicine, Washington, DC: National Academy Press.
73.
Stavrositu, C., & Sundar, S.S. ( 2008). If Internet credibility is so iffy, why the heavy use? The relationship between medium use and credibility. Cyberpsychology & Behavior, 11, 65-68.
74.
Su, N.M., Wang, Y., Mark, G., Aiyelokun, T., & Nakano, T. ( 2005, June). Bosom buddy afar brings a distant land near: Are bloggers a global community?Proceedings of the 2nd International Conference on Communities and Technologies, pp. 171-190.
75.
Sundar, S.S. ( 1998). Effect of source attribution on perception of online news stories. Journalism & Mass Communication Quarterly , 75, 55-68.
76.
Sundar, S.S. ( 1999). Exploring receivers’ criteria for perception of print and online news. Journalism & Mass Communication Quarterly, 76, 373-386.
77.
Sundar, S.S. ( 2008a). The MAIN model: A heuristic approach to understanding technology effects on credibility. In M. J. Metzger, & A. J. Flanagin (Eds.), Digital media, youth, and credibility (pp. 72-100). Cambridge, MA : The MIT Press.
78.
Sundar, S.S. ( 2008b). Self as source: Agency and customization in interactive media. In E. Konijn, S. Utz, M. Tanis , & S. Barnes (Eds.), Mediated interpersonal communication (pp. 58-74). New York: Routledge.
79.
Sundar, S.S., Edwards, H.H., Hu, Y., & Stavrositu, C. (2007). Blogging for better health: Putting the "public" back in public health. In M. Tremayne (Ed.), Blogging, citizenship and the future of media (pp. 83-102). New York: Routledge .
80.
Sundar, S.S., & Nass, C. ( 2001). Conceptualizing sources in online news. Journal of Communication, 51(1), 52-72.
81.
Surowiecki, J. ( 2004). The wisdom of crowds. New York: Doubleday.
82.
Suzuki, L.K., & Calzo, J.P. ( 2004). The search for peer advice in cyberspace: An examination of online teen bulletin boards about health and sexuality. Applied Development Psychology, 25, 685-698.
83.
Szasz, T., & Hollender, M. ( 1956). A contribution to the philosophy of medicine. Archives of Internal Medicine, 97, 585-592.
84.
Taylor, C.B., Bryson, S., Luce, K.H., Cunning, D., Doyle, A.C., Abascal, L.B., et al. (2006). Prevention of eating disorders in at-risk college-age women Archives of General Psychiatry, 63, 881-888.
85.
Tormala, Z.L., & Petty, R.E. ( 2004). Source credibility and attitude certainty: A metacognitive analysis of resistance to persuasion. Journal of Consumer Psychology, 14, 427-442.
86.
Tuckett, D., Boulton, M., Olson, C., & Williams, A. ( 1985). Meetings between experts. London: Tavistock.
87.
Walther, J.B., & Boyd, S. ( 2002). Attraction to computer-mediated social support. In C. A. Lin, & D. J. Atkin (Eds.), Communication technology and society: Audience adoption and uses (pp. 153-188). Cresskill, NJ: Hampton Press.
88.
Walther, J.B., Wang, Z., & Loh, T. ( 2004). The effect of top-level domains and advertisements on health Web site credibility. Journal of Medical Internet Research , 6(3), e24. Retrieved June 18, 2007, from http://www.jmir.org/2004/3/e24/
89.
Wang, Z., Walther, J.B., Pingree, S., & Hawkins, R.P. ( 2008). Health information, credibility, homophily, and influence via the Internet: Web sites versus discussion groups. Health Communication, 23, 358-368.
90.
Whitten, P., Kreps, G.L., & Eastin, M.S. ( 2005). Creating a framework for online cancer services research to facilitate timely and interdisciplinary applications. Journal of Medical Internet Research, 7(3), e34. Retrieved June 18, 2007, from http://www.jmir.org/2005/3/e34
91.
World Health Organization. (2005, March 17). The World Health Organization recommends that no person under 18 should use a sunbed. Retrieved June 18, 2007, from http://www.who.int/mediacentre/news/notes/2005/np07/en/index.html
92.
Wright, K.B. ( 2000). Perceptions of on-line support providers: An examination of perceived homophily, source credibility, communication and social support within on-line support groups. Communication Quarterly, 48, 44-59.
93.
Wright, K.B., & Bell, S.B. ( 2003). Health-related support groups on the Internet: Linking empirical findings to social support and computer-mediated communication theory . Journal of Health Psychology, 8, 39-54.
